The power of the brain is incredible, so remain positive
Peter Rumford
I am delighted to introduce our guest speaker, Peter Rumford. Peter is the Clinical Director of Vardan, a state-of-the-art physiotherapy clinic in Mumbai and Delhi. He earned his Bachelor’s degree in Kinesiology from California and, thereafter, did his Doctorate in Physical Therapy from the University of California, San Francisco. In 2012, Peter qualified as a Functional Manual Therapist. He has extensive experience in sports medicine, rehabilitation and training and is affiliated with various bodies in this field. He is now based in Mumbai. In Vardan, a joint initiative between Peter’s company and the Times Group, a specific paradigm of “functional manual therapy” is practised. Given our hectic lifestyles and minimal physical activity, we are prone to stiffness, weakness and pain, especially in the back and shoulders. Peter’s goal is to empower us with ways to overcome pain and deal with our physical limitations.
— Rtn. Mudit Jain
Thank you for a great introduction. I will talk to you about Vardan and what our goals are as a clinic. Vardan specialises in functional manual therapy. I am, currently, one of the four Americans in India who train Indian physiotherapists in our technique. Once trained, the physios get certified in the technique. We are, in fact, about to hire a third batch of Indian physiotherapists.
In the field of physiotherapy, what we do is truly eclectic and more, I would venture to say, well-rounded than a lot of other approaches that I have seen. So, I chose to study this and now am here to pass it on.A recent study looked at the Indian population and found that 13 per cent of Indians have experienced pain that lasted longer than three months. My goal is to give a perspective on what pain is and how we can manage our lives better.
Pain is an unpleasant sensory and emotional experience associated with actual and potential tissue damage. Notice the word sensory: it implies both physical and emotional aspects. If you think you should hurt, you will hurt. We have adrenaline and different protective mechanisms that can protect us against pain.
Pain can appear to be a bad thing but it’s not. It protects and alerts you to danger. If pain lasts longer than three or four months your tissues have probably healed but you have moved into a negative zone and we begin to call it “chronic pain”. Whether it’s a bone fracture or a ligament strain, after 12 to 16 weeks you should be getting back to your routine activities. Any pain that persists after this period is more due to central processes known as “central sensitisation”.
Your central nervous system becomes more sensitive to input from your limbs or elsewhere in your body. There is nothing in the body that is a pain receptor. We have receptors to touch, temperature, vibration and so on; but it is a combination of these receptors that goes to our brain and helps the brain perceive things.
I had a patient see me two months ago and we did our best to identify what made her pain worse. The only thing that she could tell me was that her pain worsened when she was stressed. So, in this patient’s case, we identified that stress was the primary cause of her pain.
Healing is more multi-dimensional. Anxiety is a bell-shaped curve. When we are stressed and anxious, cortisol or adrenaline is released in massive quantities. As regards your mental and emotional well-being, these chemicals can create and perpetuate chronic inflammation. They make your body more sensitive to pain.
Functional manual therapy implies a focus on function. What it means is that we don’t focus on your pain spot. MRIs and diagnostic tests are useful. They give you the perfect location of the pain — not the problem. The problem is somewhere else in the system. So, we look at the system as a functional unit and try to create an environment that allows you to heal effectively.
Pain is a result of or results in movement dysfunction. We classify three categories of movement dysfunction. One is mechanical movement dysfunction has to do with the mobility and flexibility of your muscles and joints. the second is neuromuscular dysfunction that has to with the timing of a muscle firing. There are deep stabilising muscles and big muscles that are more responsible for moving. We need to make sure that the stabilising muscles fire before the moving muscles, or else the body loses the inherent stability of the spine and you are more likely to experience pain. We need to look at which specific muscles are not firing, in order to potentially stabilise a particular section of the spine. The third is the motor control dysfunction — which essentially means how you choose to move. We want everyone to know that it all starts with the spine, the core, and how your body is positioned.
Posture is our foundation. Further, for the immune system, your diet is very important. If you can avoid things like refined sugar, bleached flour and vegetable oils, not only will you cut down on a potential inflammation in your system, you will also cut down on the risk of insulin spikes, diabetes and different kinds of cancer.
The move towards whole foods and organic foods really is a great thing. Eat natural foods and avoid processed foods. If you don’t get a lot of sunlight and have chronic pain, it would be worth getting a blood test done to check your vitamin D levels. If you are vitamin D-deficient, get at least 10-20 minutes of sun or have a supplement. You can also speak to your primary care physician and take an injection. If you’re a vegetarian, you could be suffering from vitamin B12 deficiency because the vitamin primarily comes from meat. So, if you are a vegetarian and have chronic pain, it would help to have your vitamin B12 levels checked. Muscle cramps, numbness, fatigue and lethargy could be due to deficiency of key supplements. A lot of interesting research is being done on magnesium as well. If you are low on vitamin D, it could be because of an underlying magnesium deficiency because vitamin D cannot be converted in your body without magnesium in its active state.
If you get foot cramps and experience numbness in your feet, get a sachet of Epsom salts, pour it in water and immerse your feet for 20 minutes. It is safer than consuming it orally.
Two of my mentors and good friends, Greg and Vicky Johnson, developed functional manual therapy back in the late 1970s. They are owners of a company called the Institute of Physical Art, of which I’m an instructor. I have come to India on their behalf and through a mutual agreement with the Times Group to train Indian physios and work in Vardan.
Let’s move on to some take-home messages from my talk. Positive self-talk is very important as pain is not just sensory and physical —it is also emotional. It is not just actual tissue damage, it is potential tissue damage. The worse thing you can do is to feel bad for yourself.
Let us take the example of cancer patients. They get involved with support groups and practice yoga or meditation. They focus on positive thinking and consistently do better. They have less relapse rates and survive longer. The power of the brain is incredible; so you have to remain positive.
Use it or lose it. Motion is lotion. If you walk 10 minutes and the body start to hurt, then walk for five minutes. Start small, start slow and work your way up. Aerobic exercise helps drain off adrenaline and cortisol, so do something that gets your heart rate up for a consistent period of time. Do things you enjoy. When you feel good and when you’re happy, you have endorphins going through your system. The stress chemicals don’t bother you anymore. Remember that 50 per cent of your immune system is in your gut and if you have a food allergy you’re continually creating an inflammatory response. Omega-3 fatty acids are vital when it comes to supplements. They decrease inflammation and are healthy. When it comes to omega 6 versus omega 3, the best ratio would be something like 3:1. There’s a difference in the food that we eat and our diet makes a significant impact on our overall system.
Educate yourself and sleep well. We all heal in our sleep. If you have consistent trouble while sleeping, then you should look into it. Come to Vardan, we work with acute and chronic pain patients. I am a certified functional manual therapist and also a strength and conditioning specialist. We love variety and working with patients in different situations and of ages.
Some excerpts from the Q&A session:
Q: I have problems with my knees, lower back and shoulders. What kind of therapy would you suggest?
Peter: Let’s take your posture — how you stand. The position of your knees affects your lower back. We know that people who can’t extend their knees fully can also not extend their lumbar spine fully. This is how our system is. Our bones work as levers. If you’re having back pain, I know that your different muscles at the core aren’t firing well, irrespective of whether your leg or your shoulder is working. We believe that the pelvis is the starting point, so I would start with your pelvic bone, sacrum, tail bone and each side of your pelvis to see how your mobility, control and stability is. Then, I would look into the relationship of your knees with the overall body. We will basically look at your posture and different movements.
Q: If you dip your feet in magnesium, how do you expect it to work?
Peter: It gets absorbed 40 per cent more than if it were taken orally. Studies have concluded this. There are other nuances too. If you take calcium with a magnesium pill, then the body absorbs calcium and magnesium doesn’t get into the system.
Q: What about warm-ups and stretching before exercise?
Peter: Warm-ups should be fast walks or light jogs followed by active movements that recreate the motions you are going perform. Avoid static stretching such as different yoga poses. Research shows that in sprinters and jumpers, sprinting time and jump height decreases after static stretching. There’s an elastic recoil to our muscles that is important from the standpoint of performance and prevention of injury. If I stretch the muscles around my ankles too much, I could strain the ankle because the natural recoil in the tendons might be less and my ligaments might have to work harder.